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11100069 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21690 ALCAZAR AVE CONTRACTOR:M&S ROOFING CO. PERMIT NO: 11100069 OWNER'S NAME: YOUNG CHARLES C ET AL 208 COPCO LN DATE ISSUED: 10/11/2011 C—NER'S PHONE: 4082557355 SAN JOSE,CA 95123 PHONE NO:(408)314-0870 Lr LICENSED CONTRACTOR'S DECLARATION {` j r �p BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class__�� Lic.# .O , 2—� C� MECH RESIDENTIAL COMMERCIAL Contractor s Date J cry-//-- / i I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF 30SQ,REMOVE SHAKE,50YR PRESIDENTIAL (commencing with Section 7000)of Division 3 of the Business&Professions ROOF Code and that my license is in full force and effect. CLASS A 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$13500 permit is issued. APPLICANT CERTIFICATION I^ _11� APN Number:35719097.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS O LAST CA E INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date r pc�/ �,, Issued by: /� 1 Date: OWNER-BUILDER DECLARATION RE-ROOFS: i hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: ICD I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined b the Bay Area Air y y Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner authorized agent: y forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c- and expenses which may accrue against said City in consequence of the ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION all non-point source regulations per the Cupertino Municipal Code,Section 9.18• I understand my plans shall be used as public records. Signature Date Licensed Professional 0 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO. CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333 • buildina aecuoertino.ora PROJECT ADDRESS / I , e I APN# 11V / F OWNER NAME ,` STREET ADDRESS / �► , /��o CITY STATE,. '� �/ FAX APPLICANT NAME `p /ry( / LP ONE`S',/ ( E-MATT. Jet- 5 � .o$ � L/7 3 I FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT XCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGNEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 7� LI�F�R I LICE�TYPE / I BUS.LTC.# COMPANY NAME A E-MAIL I FAX STREET ADDRES4-Z �^ e CITY,W- ONE ARCHITECT/ENGR4EERNAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA:,} VALUATION: STRUCTURE: ❑ Commercial (�� EXISTING ROOF TYPE: ❑BUILT-UP ROOF 12 ASPHALT SHINGLES 14WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLA IF NO, PLYWOOD ❑ 'e ❑ PLYWD ❑ OSB PITCH: ROOF ( NO) I #LAYERS; THICKNESS: 13 5/8" I TYPE: 11 12 CDX I CLASS: A ICC-ES REPORT# PROPOSED ROOF TYPE: ❑BUILT-UP ROOF )tASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER DESCRIPTION OF WORK �j f S 41 � /Z 7,-'2— f . /'Z 4,;i.O 01rl By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b IdI cons— ction authorize presentatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of Applicant/Agen-t Date: SUPPLEMENTAL INFORMATION REQUIRED' - -Ifbuilding is associated With a Home Owner's Association,provide letters=' of approval from HOA. —Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. _' ._ ._= �n Provide signed co of = ! COPY Cupertino's Tear-Off Policy. CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35719097. 00 DATE ISSUED. . . . . . . : 10/11/2011 RECEIPT #. . . . . . . . . : BS000015003 REFERENCE ID # . . - : 11100069 SITE ADDRESS . . . . . : 21690 ALCAZAR AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : YOUNG CHARLES C ET AL ADDRESS . . . . . . . . . . : 21690 ALCAZAR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5901 RECEIVED FROM . . . . : M & S ROOFING CO CONTRACTOR . . . . . . . : MIRSAD KRAJWIC LIC # 28360 COMPANY . . . . . . . . . . : M & S ROOFING CO. ADDRESS . . . . . . . . . . : 208 COPCO LN CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 314-0870 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 13, 500. 00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 13, 500 . 00 1.35 0 . 00 1 .35 0. 00 1REROOFRES SQ FEET 30. 00 420. 00 0 . 00 420 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 422 .35 0 . 00 422 .35 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333-buildinq(cDcur)ertino.orq PROJECT ADDRES_k J /' 'a ^ ,I APN# OWNER NAME //�'�f� PHONF7 � ; E-MAIL STZ 9(D9RE `Oi C ow�CITY, STAB,ZAP FAX CONTRACTOR N`ME� `/� LICENSE NUMBER � I LICENSE TYPE BUS.LIC.# COMPANY N�_A�,ME n C � E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777- 3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection. For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. Progress and Final Inspections will be given a two hour window. 3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailint!Inspection is required. 5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. Progress Inspection is required when approximately 50% of roof covering is installed. 7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Reside tial de. `/f Signature of Applicant/Age '`' Date:IO i Rerootpolicv_2011.doc revised 02/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21690 Alcazar Ave I DATE: 10/11/2011 REVIEWED BY: Sylvia APN: I BP#: "VALUATION: 1$13,500 'PERMIT TYPE: Minor Building Permit I PLAN CHECK TYPE: Re-roof PRIMARY I PENTAMATION 1 SFDWLROOF i USE: SFD or Duplex i PERMIT TYPE: WORK I Re-roof 30 sq, remove shake, 50 yr presidential roof, Class A SCOPE FEE ID ROOF AREA (s.E) 1REROOFFRES 3,000 A I I I I I I I I I I I I I o � uI Lj � NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (1,ee Resohrtion 11-053 Eff. 7-1./11) FEE QTY/FEE I MISC ITEMS n I � Permit Fee: $420.00 n n i � Work Without Permit? ® Yes No $0.00 Strona Motion Fee: IBSEISMICR $1.35 Select an Administrative Item Bldv_ Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $422.35 $0.00 TOTAL FEE: I $422.35 Revised: 10/01/2011 Building Department City Of Cupertino is 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: '2. /G '¢� CA'O'?Z 4rVZ -*yw kRMIT# ► I r; L� �,,� OWNER'S NAME: !/Te7- cje �5 Z, ^yP PHONE# GENERAL CONTRACTOR: /--t— 5 USINESS LICENSE# ADDRESS: -?' C,,f CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Roe I J Tile /1' Owner/Contractor Signature Date